Pancreatic ductal neoplasm

Abstract

Objective: To present a comprehensive analysis of pancreatic ductal adenocarcinoma (PDAC), addressing its main pathophysiological, epidemiological, clinical, diagnostic, and therapeutic aspects, with emphasis on the challenges related to early diagnosis and disease management. Literature review: PDAC accounts for the majority of pancreatic neoplasms and is characterized by high aggressiveness and a low resectability rate at diagnosis. Its pathophysiology involves frequent KRAS mutations, in addition to alterations in TP53, CDKN2A, and SMAD4, associated with an intense desmoplastic and immunosuppressive tumor microenvironment. Incidence and mortality show a rising trend worldwide. Risk factors include genetic predisposition, chronic pancreatitis, newly diagnosed diabetes, smoking, obesity, and alcohol consumption. Clinical presentation is nonspecific, including abdominal pain, weight loss, and jaundice. Diagnosis is based on pancreatic protocol computed tumor markers such as CA 19-9, and histological confirmation by endoscopic ultrasound. Treatment depends on staging, involving surgery when feasible and systemic chemotherapy, with recent advances in targeted therapies and immunotherapy. Final Considerations: Despite scientific advances, PDAC maintains a poor prognosis, reinforcing the need for strategies that promote earlier diagnosis and more effective therapies.